Application of B-Lines in Lung Ultrasound for Early Diagnosis of Acute Respiratory Distress Syndrome
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Abstract
Background: Bedside lung ultrasound (LUS) is increasingly being used in diagnosing various lung pathologies. Acute respiratory distress syndrome (ARDS), one of such lung pathology, is a major underlying cause of mortality in critically ill patients. Early diagnosis of ARDS can improve the outcome in such patients. The primary objective of this study is to explore application of B-lines in LUS for early detection of developing ARDS in susceptible patients.
Methods: This is a prospective cohort study. This study enrolled patients admitted in intensive care unit. Daily clinical evaluation, bedside chest x ray and bedside lung ultrasound done to diagnose ARDS. Mean days of diagnosing ARDS by chest x ray and LUS were compared using t-test. Area under the Receiver Operating Curves Characteristics was calculated with a 95% confidence interval to determine the prognostic value of LUS.
Results: Out of a total of 100 participants, 28 patients developed ARDS. Lung ultrasound was found to diagnose ARDS significantly earlier then chest x ray (p=0.001).
Conclusion: Results in this study showed that B-line score in patients susceptible to develop ARDS can help in early diagnosis of the same.
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[9] Picano E, Pellikka PA. Ultrasound of extravascular lung water: A new standard for pulmonary congestion. Eur Heart J. 2016; 37:2097–104.
[10] Mittal AK, Jaipuria J, Patel A, Bhatnagar V, Chawla R, Singh S. Utility of lung ultrasound for extravascular lung water volume estimation during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Indian J Anaesth. 2021; 65:458-64.
[11] Copetti R, Soldati G, Copetti P. Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome. Cardiovasc Ultrasound. 2008; 6:16.
[12] Ciesla DJ, Moore EE, Johnson JL, Cothren CC, Banerjee A, Burch JM, et al. Decreased progression of postinjury lung dysfunction to the acute respiratory distress syndrome and multiple organ failure. Surgery. 2016; 140:640–648.
[13] Lellouche F, Lipes J. Prophylactic protective ventilation: lower tidal volumes for all critically ill patients? Intensive Care Med. 2013; 39:6–15.
[14] Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, et al. International evidence-based recommendations for point-of care lung ultrasound. Intensive Care Med. 2012; 38:577–91.
[15] Bouhemad B, Liu ZH, Arbelot C, Zhang M, Ferarri F, Le-Guen M, et al. Ultrasound assessment of antibiotic-induced pulmonary reaeration in ventilator-associated pneumonia. Crit Care Med. 2010; 38:84–92.
[16] Bouhemad B, Brisson H, Le-Guen M, Arbelot C, Lu Q, Rouby JJ. Bedside ultrasound assessment of positive end-expiratory pressure-induced lung recruitment. Am J Respir Crit Care Med. 2011; 183:341–7.
[17] Soummer A, Perbet S, Brisson H, Arbelot C, Constantin JM, Lu Q, et al. Ultrasound assessment of lung aeration loss during a successful weaning trial predicts postextubation distress. Crit Care Med. 2012; 40:2064–72.
[18] Lichtenstein DA, Meziere GA, Lagoueyte JF, Biderman P, Goldstein I, Gepner A. A-lines and B-lines: lung ultrasound as a bedside tool for predicting pulmonary artery occlusion pressure in the critically ill. Chest. 2009; 136:1014–20.
[19] Tierney DM, Huelster JS, Overgaard JD, Plunkett MB, Boland LL, St Hill CA, et al. Comparative performance of pulmonary ultrasound, chest radiograph, and CT among patients with acute respiratory failure. Crit Care Med. 2020; 48:151–7.
[20] Agricola E, Bove T, Oppizzi M, Marino G, Zangrillo A, Margonato A, et al. “Ultrasound comet-tail images”: A marker of pulmonary edema-A comparative study with wedge pressure and extravascular lung water. Chest. 2005; 127:1690–1695
[21] Lichtenstein D, Goldstein I, Mourgeon E, Cluzel P, Grenier P, Rouby JJ. Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology. 2004; 100(1):9-15.
[22] Riviello ED, Kiviri W, Twagirumugabe T, Mueller A, Banner-Goodspeed VM, Officer L, et al. Hospital Incidence and Outcome of the Acute Respiratory Distress Syndrome Using the Kigali Modification of the Berlin Definition. Am J Respir Crit Care Med. 2016; 193:52-9.
[23] Leopold SJ, Ghose A, Plewes KA, Mazumder S, Pisani L, Kingston HWF, et al. Point-of-care lung ultrasound for the detection of pulmonary manifestations of malaria and sepsis: An observational study. PLoS ONE. 2018; 13:e0204832.
[24] Leblanc D, Bouvet C, Degiovanni F, Nedelcu C, BouhoursG, Rineau E, et al. Early lung ultrasonography predicts the occurrence of acute respiratory distress syndrome in blunt trauma patients. Intensive Care Med. 2014; 40:1468-74.
[2] Singh G, Gladdy G, Chandy T, Sen N. Incidence and outcome of acute lung injury and acute respiratory distress syndrome in the surgical intensive care unit. Indian J Crit Care Med. 2014; 18:659-665.
[3] Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute Respiratory Distress Syndrome: the Berlin Definition. JAMA. 2012; 307:2526-33.
[4] Constantin JM, Grasso S, Chanques G, Aufort S, Futier E, Sebbane M, et al. Lung morphology predicts response to recruitment maneuver in patients with acute respiratory distress syndrome. Crit Care Med. 2010; 38:1108–17.
[5] Sweeney RM, McAuley DF. Acute respiratory distress syndrome. Lancet. 2016; 388:2416–2430.
[6] Baldi G, Gargani L, Abramo A, D’Errico L, Caramella D, Picano E, et al. Lung water assessment by lung ultrasonography in intensive care: a pilot study. Intensive Care Med. 2013; 39:74–84.
[7] Mongodi S, Bouhemad B, Orlando A, Stella A, Tavazzi G, Via G, et al. Modified lung ultrasound score for assessing and monitoring pulmonary aeration. Ultraschall Med. 2017; 38:530–7.
[8] Bataille B, Rao G, Cocquet P, Mora M, Masson B, Ginot J, et al. Accuracy of ultrasound B-lines score and E/Ea ratio to estimate extravascular lung water and its variations in patients with acute respiratory distress syndrome. J Clin Monit Comput. 2014; 29:169–176.
[9] Picano E, Pellikka PA. Ultrasound of extravascular lung water: A new standard for pulmonary congestion. Eur Heart J. 2016; 37:2097–104.
[10] Mittal AK, Jaipuria J, Patel A, Bhatnagar V, Chawla R, Singh S. Utility of lung ultrasound for extravascular lung water volume estimation during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Indian J Anaesth. 2021; 65:458-64.
[11] Copetti R, Soldati G, Copetti P. Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome. Cardiovasc Ultrasound. 2008; 6:16.
[12] Ciesla DJ, Moore EE, Johnson JL, Cothren CC, Banerjee A, Burch JM, et al. Decreased progression of postinjury lung dysfunction to the acute respiratory distress syndrome and multiple organ failure. Surgery. 2016; 140:640–648.
[13] Lellouche F, Lipes J. Prophylactic protective ventilation: lower tidal volumes for all critically ill patients? Intensive Care Med. 2013; 39:6–15.
[14] Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, et al. International evidence-based recommendations for point-of care lung ultrasound. Intensive Care Med. 2012; 38:577–91.
[15] Bouhemad B, Liu ZH, Arbelot C, Zhang M, Ferarri F, Le-Guen M, et al. Ultrasound assessment of antibiotic-induced pulmonary reaeration in ventilator-associated pneumonia. Crit Care Med. 2010; 38:84–92.
[16] Bouhemad B, Brisson H, Le-Guen M, Arbelot C, Lu Q, Rouby JJ. Bedside ultrasound assessment of positive end-expiratory pressure-induced lung recruitment. Am J Respir Crit Care Med. 2011; 183:341–7.
[17] Soummer A, Perbet S, Brisson H, Arbelot C, Constantin JM, Lu Q, et al. Ultrasound assessment of lung aeration loss during a successful weaning trial predicts postextubation distress. Crit Care Med. 2012; 40:2064–72.
[18] Lichtenstein DA, Meziere GA, Lagoueyte JF, Biderman P, Goldstein I, Gepner A. A-lines and B-lines: lung ultrasound as a bedside tool for predicting pulmonary artery occlusion pressure in the critically ill. Chest. 2009; 136:1014–20.
[19] Tierney DM, Huelster JS, Overgaard JD, Plunkett MB, Boland LL, St Hill CA, et al. Comparative performance of pulmonary ultrasound, chest radiograph, and CT among patients with acute respiratory failure. Crit Care Med. 2020; 48:151–7.
[20] Agricola E, Bove T, Oppizzi M, Marino G, Zangrillo A, Margonato A, et al. “Ultrasound comet-tail images”: A marker of pulmonary edema-A comparative study with wedge pressure and extravascular lung water. Chest. 2005; 127:1690–1695
[21] Lichtenstein D, Goldstein I, Mourgeon E, Cluzel P, Grenier P, Rouby JJ. Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology. 2004; 100(1):9-15.
[22] Riviello ED, Kiviri W, Twagirumugabe T, Mueller A, Banner-Goodspeed VM, Officer L, et al. Hospital Incidence and Outcome of the Acute Respiratory Distress Syndrome Using the Kigali Modification of the Berlin Definition. Am J Respir Crit Care Med. 2016; 193:52-9.
[23] Leopold SJ, Ghose A, Plewes KA, Mazumder S, Pisani L, Kingston HWF, et al. Point-of-care lung ultrasound for the detection of pulmonary manifestations of malaria and sepsis: An observational study. PLoS ONE. 2018; 13:e0204832.
[24] Leblanc D, Bouvet C, Degiovanni F, Nedelcu C, BouhoursG, Rineau E, et al. Early lung ultrasonography predicts the occurrence of acute respiratory distress syndrome in blunt trauma patients. Intensive Care Med. 2014; 40:1468-74.
| Files | ||
| Issue | Vol 9 No Supp. 2 (2023): Supplement 2 |
|
| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v9i6.14442 | |
| Keywords | ||
| Acute respiratory distress syndrome(ARDS) Lung ultrasound B-Lines | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
. S, Lamba P, Bhardwaj S. Application of B-Lines in Lung Ultrasound for Early Diagnosis of Acute Respiratory Distress Syndrome. Arch Anesth & Crit Care. 2023;9(Supp. 2):469-473.
